reproductive health 2

fibrocystic breast changes

thickening of normal breast tissue

etiology of fibrocystic breast changes

probably due to imbalance of estrogen and progesterone

symptoms of fibrocystic breast changes

• cyclic pain (more pain around certain times of menstrual cycle

• tenderness

• swelling right before menses

diagnosis of fibrocystic breast changes

mammography MRI or fine needle aspiration

treatment of fibrocystic breast changes

• limit caffeine

• decrease sodium

• use oral contraceptives

endometriosis

presence of endometrial tissue outside of uterus

etiology of endometriosis

cause unknown, maybe due to backflow of menstrual flow, inflammation of endometrium, immune defect

symptoms of endometriosis

pelvic pain usually at time of menses

diagnosis of endometriosis

confirmed by laparoscopy

treatment of endometriosis

surgical removal of endometrial tissue, NSAIDs, oral contraceptives

polycystic ovarian syndrome (PCOS)

ovaries enlarged and contain numerous small cysts along outer edge of ovary

etiology of PCOS

cause unknown

symptoms of PCOS

• irregular to absent menses

• elevated testosterone and androgen levels, obesity, insulin resistance, and infertility

diagnosis of PCOS

• H&P

• labs

• vagina US to evaluate uterus and ovaries

treatment for PCOS

oral contraceptives, glucophage and spironolactone

toxic shock syndrome (TSS)

disease in women of their reproductive years around menses or postpartum

etiology of TSS

toxin released by Staph A

symptoms of TSS

• fever

• rash on trunk that resembles sunburn

• vomiting

• hypotension

• inflamed mucous membranes

diagnosis of TSS

• elevated BUN, AST, ALT, bili

  • low platelets

treatment for TSS

hospitalization, IVF to maintain BP, antibiotics

bacterial vaginosis (BV)

decrease in normal vaginal flora (natural defense)

etiology of BV

overgrowth of bacteria probably due to frequent sex or douching

symptoms of BV

increased amount of thin, watery, whitish/grey fluid with a fishy smell

diagnosis of BV

• vaginal pH greater than 4.5

• slide prep

treatment of BV

• Flagyl (metronidazole)

• clindamycin vaginal cream

vaginal candidiasis

yeast infection

etiology of vaginal candidiasis

• antibiotics

• oral contraceptives

• immunosuppressants

• diabetes

symptoms of vaginal candidiasis

thick, curdy vaginal dishcarge, severe itching, rash

diagnosis of vaginal candidiasis

vaginal discharge will show spores under microscope

treatment of vaginal candidiasis

Diflucan (fluconazole) or nystatin

trichomoniasis

most common non-viral sexually transmitted infection

etiology of trichomoniasis

caused by Trichomoniasis Vaginalis

symptoms of trichomoniasis

yellow/green discharge, inflammation, itching, dysuria

diagnosis of trichomoniasis

visualization of organism on microscope slide

treatment of trichomoniasis

Flagyl (metronidazole) vs non-treatment (risk of preterm labor or complications with pregnancy such as increased risk for premature rupture of membranes and low fetal birth weight if treated while pregnant)

chlamydial infection

most common bacterial sexually transmitted disease

etiology of chlamydia

caused by chlamydia trachomatis

symptoms of chlamydia

thin, purulent discharfe, dysuria, lower abdominal pain

diagnosis of chlamydia

lab culture

treatment of chlamydia

azithromycin

what can happen if chlamydia is not treated during pregnancy?

can lead to blindness and pneumonia in newborn (neonatal conjunctivitis)

gonorrhea

STD increasing risk for pelvic inflammatory disease (PID)

etiology of gonorrhea

bacteria Neiserria gonorrhoeae

symptoms of gonorrhea

purulent, yellow/greenish discharge, dysuria, vulva swelling

diagnosis of gonorrhea

lab culture

treatment of gonorrhea

rocephin (ceftriaxone) and azithromycin

what can happen if mom is not treated for gonrrhea during pregnancy?

gonococcal ophthalmia neonatorum

herpes genitalis

HSV 1 (cold sore) and HSV 2 (genital infection)

etiology of herpes genitalis

caused by herpes simplex virus

symtpoms of herpes genitalis

single, blister-like vesicle in genital area, itching and tingling prior to vesicle appearing

diagnosis of herpes genitalis

culture of lesion

treatment of herpes genitalis

no cure, acyclovir to help keep virus dormant

when do vesicles appear with herpes genitalis?

a few hours to 20 days after exposure

when will lesions heal themselves

two to four weeks

what can trigger a flare up of herpes genitalis?

• stress

• menstruation

• pregnancy

• frequent sex

• tight clothing

• over-heating

why should women with herpes genitalis not have a vaginal delivery?

if baby comes in contact with vesicle and contracts virus, it could be fatal

syphilis

chronic infection from contact with open wound or acquired congenitally

etiology of syphilis

spirochete treponema pallidum

symptoms of syphilis

chancre then later wart-like plaque on vulva, fever, weight loss, malaise

diagnosis of syphilis

blood test VDRL or RPR

treatment of syphilis

penicillin

human papillomavirus (HPV)

sexually transmitted through vaginal, oral, or anal sex, usual cause of cervical cancer

etiology of HPV

human papillomavirus

symptoms of HPV

genital warts

diagnosis of HPV

biopsy lesion

treatment of HPV

cryotherapy, shave excision, acid removal

pelvic inflammatory disease (PID)

inflammatory disorder of upper female genitalia, can cause tubal damage and infertility

etiology of PID

eomen with multiple sexual partners, use of IUD, untreated gonorrhea and chlamydia

symptoms of PID

bilateral sharp cramping pain, fever, chills, purulent vaginal discharge

diagnosis of PID

cultures, CBC, VRDL, RPR

treatment of PID

multiple antibiotic combos

cystitis

lower urinary tract infection

etiology of cystitis

E. coli, enterococcus, or staph

symptoms of cystitis

low grade temp, hematuria, painful urination

diagnosis of cystitis

urine specimen, labs

treatment of cystitis

antibiotics

pyelonephritis

upper urinary tract infection

etiology of pyelonephritis

proceeded by lower UTI

symptoms of pyelonephritis

high temp, chills, flank pain

diagnosis of pyelonephritis

urine specimen, labs

treatment of pyelonephritis

IVF, IV antibiotics, pain meds

infertility

unprotected sexual intercourse over 12 month time period where conception does not occur

secondary infertility

unable to conceive or sustain a pregnancy after 1 or more successful pregnancies

essential components of female fertility

• favorable cervical mucus

• patent tubes with normal motility

• ovaries that produce and release normal ova

• no obstruction between ovary and uterus

• favorable endometrium

• adequate reproductive hormones

essential components of male fertility

• normal quality, quantity, and motility of sperm

• unobstructed genital tract

• normal genital tract secretions

• ejaculated sperm able to reach cervix

ways to improve fertility

• no douching or artificial lubricants

• retain and avoid leaking sperm for at least 20-30 minutes after intercourse

• sex every other day during fertile period

• decrease anxiety and stress

• adequate nutrition

infertility workup for female with ovulatory problems

• basal body temp (BBT)

• cervical mucus changes

• hormonal assessment

• endometrial biopsy

• transvaginal US

basal body temperature (BBT)

body temperature increases when progesterone increases, so women will take their temperature to determine fertile window

cervical mucus changes

thin, watery discharge indicates fertile window

hormonal assessment

check FSH and LH levels; day of LH surge is probably a woman’s most fertile daym

male infertility workups

ductal obstruction or abnormal sperm/sperm production

infertility treatments/options

• meds

• therapeutic insemination

• in vitro fertilization (IVF)

• gamete intrafallopian transfer

• zygote intrafallopian transfer

• adoption

medications for infertility

clomid (clompihene citrate) stimulates follicle growth and release of eggs, progesterone, gonadotropins (FSH, LH), parlodel (bromocriptine) inhibits prolactin which will increase FSH and LH levels

therapeutic insemination

donor or husband’s sperm deposited at cervical os or uterus mechanically

in vitro fertilization (IVF)

egg collected from ovary, fertilized in lab and placed in uterus after embryo development starts

gamete intrafallopian transfer

egg removed by laparascopy and placed with sperm, fertilization occurs in fallopian tube, then egg travels to uterus to implant

zygote intrafallopian transfer

egg retrieved and incubated with sperm and placed back into fallopian tubes oncer fertilization occurs

adoption

• get info from reliable sources

• international vs domestic agencies

• reputable adoption agencies

• can be expensive and time consuming

effects of infertility

• stress on marriage or relationship

• relationship affected by intrusiveness

• guilt

• frustration

• anger

• shame

• loss of control

• feelings of incompetence or defectiveness

• sense of social stigma

• strained relationship with HCP

• loss of status and ambiguity as couple

genetic disorders

hereditary material carried on strands of DNA as chromosomes (22 pairs are non-sex chromosomes, 1 pair is sex chromosome)